ndividuals who have group insurance
through their employer should enroll in
their employer’s plan during the plan’s
annual Open Enrollment period, as usual.
Likewise, individuals who are Medicareeligible should enroll in Medicare during
Medicare’s annual Open Enrollment period,
which is Oct. 15 through Dec. 7 (see article on
page 8 for more details about Medicare).

TOP 10

The

SECRETS
to a long and healthy life
Sound advice from the experts

BY DEBRA GELBART

B

elow are 10 steps you can take at any age to
supplement the good-sense actions — watching
your weight, not smoking, exercising and more — you’ve
hopefully already made part of your everyday lifestyle.

2

Protect
cognitive
function. There is a lot of

Levels of coverage

For example, within each company’s
products, a bronze plan will probably be
more affordable than a silver plan, but almost
certainly will not provide as many benefits
as a silver plan. Likewise, a silver plan will
most likely be more affordable than a gold
plan. Some companies may offer a platinum
product with premium coverage, but, as
its name implies, it will probably be more
expensive, so you will need to do a personal
cost-benefit analysis that includes items
such as monthly premiums, deductibles and
co-pays to determine what level of coverage
at what price is best for you and your family.

Essential benefits
All private health insurance plans offered in
the Marketplace will offer the same set of
essential health benefits, which are minimum
requirements for all plans in the Marketplace.
Some plans may offer additional coverage;
you will see exactly what each plan offers
when you compare them side-by-side in
the online Marketplace at healthcare.gov.
The essential health benefits include:
• Ambulatory care (outpatient care you
get without being admitted to a hospital)
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health, substance-abuse and
behavioral-health treatment
• Prescription drugs
• Rehabilitative and habilitative services
and devices
• Laboratory services
• Preventive and wellness services;
chronic disease management
• Pediatric services
More info: Visit healthcare.gov or call
800-318-2596 (TTY: 1-855-889-4325)
24 hours a day, seven days a week.

The September issue of
Living Well included several
articles on the Affordable
Care Act. Topics include:
• Explaining the Health Insurance
Marketplace
• Who can participate
• Levels of coverage
• Calculating costs
• Subsidies and penalties
• Questions to ask
• Enroll America
You can access the e-flipbook at:
http://issuu.com/rmcp/docs/livingwellazseptember2013?e=4031137/4702435

RICK D’ELIA

The U.S. Health and Human Services website,
healthcare.gov, details which insurance
companies are participating in the Marketplace.
It also describes the levels of coverage
available, which are called bronze, silver, gold
and platinum. Each level will be standardized
according to its range of benefits and each is
based on how you and the plan can expect
to share the costs of your care. The categories
do not reflect the quality or amount of care
the plans provide.

ABOVE: Aneil Koerper, health
and fitness program manager for
The Terraces, a continuum of care
community, runs a ‘boot camp’
exercise class for residents.
RIGHT: Koerper works with
Barbara Quarles on her flexibility
and mobility through stretching
and walking drills.

information related to warding off
mental decline by working on
puzzles and taking on mental
challenges such as learning another
language. While these activities can
certainly be helpful, some experts
say that they are not the most
important thing you can do to
preserve cognition as you age.
Indeed, Janko Nikolich-Zugich,
M.D., Ph.D., head of the Department
of Immunobiology as well as
co-director of the Arizona Center on
Aging at the University of Arizona
College of Medicine in Tucson,
said that the most critical factor
in preventing neurodegenerative
diseases is staying physically active.

1

Fully
understand
the benefits of
exercise. “The bad news

is that the aging process starts at
age 30,” said Aneil Koerper, the
health and fitness program
manager at The Terraces, a
continuum of care retirement
community in central Phoenix. The
good news, she said, is that you can
compensate for the aging process
by engaging in both cardio and
muscle-strengthening activities
such as dancing, jumping rope (on
carpet, not on a hard surface), using
a stair-climber or walking up stairs.
“If you like dancing, take a
Zumba or line-dancing class,” she
suggested. “Fast dance steps are a
great way to increase the power in
your leg muscles, and maintaining
that power will increase your
balance and reduce the possibility
of falls as you age.” She also
recommends wall-squats, where
you stand with your back against a
wall and slowly squat down as far as
you can. If you go to a gym, use the
leg-press machine to accomplish
the benefits of wall-squats, she said.
Ideally, you’ll want to incorporate
exercise into your routine that
promotes endurance (short
periods of more intense aerobics),
muscle strength (weight lifting),
flexibility (yoga) and balance
(tai chi), said Walter Nieri, M.D.,
a geriatrician and internal
medicine physician and
director of Banner Sun
Health Research Institute’s
Center for Healthy Aging.

If you’re over 30, you should have a
yearly well-visit with a primary care
provider, Nieri said. “It’s important
that your blood pressure, cholesterol,
blood sugar and thyroid function be
evaluated regularly,” he said.

4

Manage
stress. “I’m in favor

of teaching stress management
techniques as early as high school,”
Nieri said. “It’s important to learn
that ongoing stress can significantly
impact your health.”
Continued on page 9 HEALTHY AGING

The basics of BRCA genes and cancer

Determining yyour
our individual
individual rrisk
isk
Determining

A

ccording to Mary Cianfrocca, D.O.,
director of the Breast Cancer
Program and medical director of the Clinical
Cancer Genetics Program at Banner MD
Anderson Cancer Center in Gilbert, less than
10 percent of breast cancer patients have
either the BRCA1 or BRCA2 susceptibility
gene mutation. “BRCA genes predispose
a woman to breast cancer, ovarian cancer
and various other forms of cancer, but it’s
not a guarantee that cancer will develop,”
she said. “Also, the vast majority of cancers
occur sporadically.”
Furthermore, the risk varies between
BRCA genes. Robert Kuske, M.D., medical
director of Arizona Breast Cancer
Specialists, said that the lifetime risk of
developing breast cancer is between
75 and 85 percent for BRCA1 and BRCA2
carriers, while the risk of the more lethal
ovarian and/or fallopian tube cancer
is up to 44 percent.

Not just women

Pointing out that women are not the only
ones who need to understand the risks,
Kuske said that in addition to passing
the genes on to their children, men who
are BRCA carriers face their own risk of
developing breast cancer or another
form of cancer.
“Men usually do not get tested for
BRCA1/2, but their risk of breast cancer
is between one and 10 percent,” he said.
“If they carry the gene, they have a

BURNETT
KRI
NE BU
RIST
STIN
ST
IN
B
BURN
URN
RNET
ETTT
ET
BY KRISTINE

three- to seven-fold increased risk of
prostate cancer. Pancreatic cancer also
is associated with BRCA1/2.”

Genetic testing

While having a BRCA gene is certainly
cause for concern, not everyone can
or should be tested for the mutation.
Determining whether to undergo genetic
testing is based on one’s personal and/or
family health history.
Mike Janicek, M.D., gynecologic
oncologist with Arizona Oncology and
medical director of the Virginia G. Piper
Cancer Center’s Cancer Genetic Risk
Assessment and Prevention Program,
clarified the role of genetics and family
history. “Disease patterns in families can
tell a lot about what to look for, what
preventive measures to consider, and even
which treatment approaches are most
appropriate,” he said. “Recognizing these
patterns promptly can be life-saving.”
Cianfrocca stressed the importance of
looking at all types of cancer in the family
as well as ancestry (including countries
of origin) since certain ethnicities have
an increased risk. She highlighted factors
such as a presence of cancer under age
50, same or related cancers among two
or more relatives on the same side of the
family, breast and ovarian cancer in the
same family, male breast cancer and any
rare form of cancer as examples of reasons
for genetic testing.

Free online disease
mapping and pedigree
tools like the Surgeon
General’s My Family
Health Portrait (available
on the U.S. Department
of Health and Human
Services website,
FamilyHistory.hhs.gov)
can help determine your
individual risk.
Informed decision-making

Confirming the presence of BRCA1/2
enables people to make informed
decisions about their health. This could
include preventive breast and/or ovary
and/or fallopian tube removal or enhanced
active surveillance and screening. Janicek
noted that there is a relatively new class
of drugs called PARP inhibitors that are
designed specifically for cancer patients
with BRCA genes.
“How to proceed following confirmation
of BRCA1/2 is an incredibly personal choice
and women need to know they have
options,” Kuske said. “About 60 percent of
my patients choose preventive surgery.
The social and emotional implications of
surgery weigh heavily on one’s decision.”

THINKSTOCK

2 | LIVING WELL A-Z | WEDNESDAY, October 2, 2013

Insurance coverage

Though not all insurance plans cover
genetic testing, Janicek said many
insurance companies do want high-risk
patients to be tested. “It’s much less
expensive to pay for preventive care
than cancer treatment,” he said.
If not covered by their insurance plan,
a person can elect to pay out-of-pocket,
something Kuske recommends for
individuals who may be paralyzed by
the fear of not knowing whether they
carry a gene mutation.
For those who may worry that
genetic testing could lead to denial
of insurance coverage, Kuske hopes
to calm their fears by discussing the
Affordable Care Act and its stance on
not allowing coverage exclusions based
on pre-existing conditions.

Look for Livingwell a-z on the first Wednesday of each month! Each month, we bring you local health information you can use to keep you and
your family living well. From A to Z, we tackle a broad range of health issues and offer you a wealth of resources where you can find more specific information. This publication is produced by
Republic Media Custom Publishing. For questions concerning any content included in this publication please contact: Editor Paula Hubbs Cohen, Paula.Cohen@cox.net or call 602-444-8658.
A division of The Arizona Republic.
200 E. Van Buren St., Phoenix, AZ 85004

With Phoenix Health Plans, you can get numerous Medicare benefits not
covered by Original Medicare like vision and dental coverage — benefits that
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To learn more, visit us online at www.phoenixhealthplans.com or call

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H5985_044-2014 CMS Accepted

Flu shots 101
It’s that time of year

D

BY ALISON STANTON

uane Wooten, M.D., a pediatrician at Rainbow
Pediatrics in Phoenix, said that the American
Academy of Pediatrics, the American Medical
Association and “pretty much everybody in the world”
says that everyone over the age of 6 months should get
immunized against the flu.
“This is especially true
“The nasal
for people who have some
mist is an
debilitating health condition
that puts them at a higher
alternative for
risk of getting sick,” he said.
people who
Karen Lewis, M.D., medical
have adverse
director for the Office
of Vaccine Preventable
reactions to
Diseases at the Arizona
needles.”
Department of Health
— Duane Wooten, M.D.,
Services, said the flu vaccine
a pediatrician at
is particularly important for
Rainbow Pediatrics
people who are at increased
risk for severe complications
from influenza, including children under age 5, people
50 years and older, pregnant women, American Indians
and Alaska Natives, people with weak immune systems
or who are extremely obese, and children and teenagers
who are receiving long-term aspirin treatment.

WEDNESDAY, October 2, 2013 | LIVING WELL A-Z | 3

Office ergonomics

Blurry eyes...achy wrists...oh my!

T

“In the office, this [proper ergonomics] is made more
challenging because sitting for hours doing repetitive
functions causes safety issues,” said Jerry Mosteller,
a certified ergonomic assessment specialist with Ergo
Focus, a company that helps organizations with
workplace ergonomic issues.

1

People who have had a severe allergic reaction
(anaphylaxis) to any previous influenza vaccine or to any
ingredient in an influenza vaccine, including eggs, should
not get a flu shot, Lewis said.
“However, people who have only mild to moderate
reactions to eggs, such as hives, can now get influenza
vaccines, but they need to be watched for 30 minutes
afterwards to make sure they do not have a severe
reaction,” she said.

GET MOVING.
“Try to
alternate
activities
which
ac
require
sitting
re
and
a concentrating
at
a a desk with
activities
that
ac
allow
allo you to move
about,”
abou said Denise
McGinley,
McGinl MSNAd, RN,
the directo
director of the Center for
Orthopaedic Innovation at St. Luke’s Medical
Center. McGinley recommended standing and
stretching every 45 minutes to an hour.

Nasal spray option

Typical side effects

The most common reaction to an influenza shot is
redness, swelling and/or some pain at the injection site,
Lewis said, adding that this is a sign that the body’s
immune system is recognizing some foreign material
and is learning how to become immune to it.

USE A
QUALITY
CHAIR.
Te
Teresa Boynton,
M
MS, OTR, an
e
ergonomics and
in
injury prevention
sp
specialist for
Ba
Banner Health,
said that important
featur
features are seat-pan
depth, se
seat width,
b
k
t height and tilt
back-support
adjustment, lumbar support, active sitting and
rocker tension, plus arm-rest adjustability, all of
which lead to overall comfort.

The problem

Egg allergy alert

One of the influenza vaccines is a live, weakened form of
influenza that comes as a nasal spray, Lewis said, noting
that it should only be used in healthy individuals ages 2 to
49 years old who are not allergic to eggs and who do not
have an underlying health issue, including pregnancy.

3

here are a wealth of health issues associated
with incorrect office ergonomics, issues that are
especially problematic for those who log-in long hours
sitting at a desk, whether in a traditional office
environment or in a home office.

6 solutions from the experts

2

REARRANGE YOUR WORKSPACE. “Arrange your
work environment so that you can easily reach
h
your phone, keyboard
eyboard and
mouse,” Mosteller
eller
said. “Arrange
o
your monitor so
that you can
see without
looking down
or straining
your neck.
Adjust your
THINKSTOCK
ou
chair so that you
d
are in a relaxed
sition.”
but neutral position.”

DON’T SIT
TOO CLOSE TO
YOUR SCREEN.
“O
“Our eyes are
m
meant for distance
vvision; sitting
to
too close to your
co
computer screen
[le
[less than 18 inches]
caus
causes the muscles
of the eyes to become
strained,” McGinley said.

“Careful consideration should be
given to the selection of office
furniture and accessories that
offer the most adjustability while
minimizing musculoskeletal
strain for the worker.”
— Brenda Taubman, MA, OTR/L, assistant
professor at Midwestern University’s
Occupational Therapy Program

From acupuncture to new meds to chromosomal testing
BY GREMLYN BRADLEY-WADDELL

J

ay Nemiro, M.D., medical director
of the Arizona Center for Fertility
Studies in Scottsdale, said that the average
person doesn’t realize the heartbreak
that goes on when a desired pregnancy
doesn’t occur. “The disappointment
is so profound,” he said.
Thankfully, though, the past
several years have seen technological
advancements — even low-tech
approaches — yield positive results for
those struggling with infertility.

Medium-tech methods

While the industry’s high-tech methods,
namely in-vitro fertilization (IVF), get most
of the media attention, H. Randall Craig,
M.D., medical director of the Fertility
Treatment Center in Scottsdale, said it’s
actually the less complicated, “mediumtech” methods that are more commonly
used to treat infertility.
That realm has seen many advances,
including the use of:
• Aromatase inhibitors, anti-cancer drugs
like Letrozole (marketed as Femara).
Although the drugs are not yet officially
FDA-approved to treat infertility,
aromatase inhibitors are frequently used
by clinics and have been shown to triple
pregnancy rates.
• Density gradient centrifugation (using
G-forces inside a centrifuge to separate
better sperm from the weaker ones). The
pregnancy rates from using aromatase
inhibitors and density gradient
centrifugation alone run about 12 to 28
percent per cycle, “pretty good odds,”

•

•

•

•

Craig said, enough to rival some IVF
methods. What’s more, this route is
considerably more affordable than IVF.
Granulocyte colony-stimulating factor, a
protein derived from bone marrow used to
treat leukemia patients. The hormone
boosts white cell counts and also
increases the
quality of a woman’s eggs when used
in conjunction with other treatments.
Acupuncture, which increases blood flow to
the uterus. When performed around the
same time embryos are transferred to
the uterus, acupuncture can increase
pregnancy rates up to 8 percent.
Bitter melon, a cucumber from India.
When patients with polycystic ovary
syndrome — which leads to irregular
periods and poor ovulation — eat
five fresh or freeze-dried seeds a day,
pregnancy rates are increased.
Glucophage, now sold as metformin, a
drug often prescribed for the treatment of
diabetes. When patients with polycystic
ovary syndrome add glucophage
to their medication regime, Craig
said there is a significant increase in
pregnancy rates and a reduction in
miscarriages.

High-tech labs

The doctors also note that numerous
breakthroughs have taken place in ART
(Assisted Reproductive Technology)
labs. Nemiro said these breakthroughs
include improved embryo-growing
mediums, which are “closer to the natural
environment” of the fallopian tubes.
Another milestone has been the ability
to grow embryos to the fifth day, or the

blastocyst stage. In the past, clinics
typically transferred lab-grown embryos
to a woman’s uterus on the third day.
But the uterus is not as receptive to
day-3 embryos as it is to day-5 embryos,
Nemiro said. The latter are stronger and
more viable, therefore improving the
odds of a successful pregnancy.

Freezing embryos

Yet another development is vitrification,
or the rapid freezing of embryos.
Just a few years ago, slow freezing
was the norm, but ice crystals that
developed during thawing often
damaged embryos. Nemiro said the
quick-freeze process, which has FDA
approval, eliminates that issue.

Screening chromosomes

But perhaps the biggest innovation
Nemiro has seen is PGD/PGS:
23-chromosome array, a process that
screens embryos for chromosomal
abnormalities with the aim of improving
pregnancy odds and reducing the
possibility of miscarriage. PGD refers
to ‘pre-implantation genetic diagnosis’
while PGS refers to ‘pre-implantation
genetic screening’.
Older technology was limited to testing
10 chromosomes, but clinics can now
screen all 23 chromosomes with over 99
percent accuracy. Nemiro views the test
as such an important part of IVF that he
charges patients the service at cost.
“I’m so excited about this technology,
I want to provide all patients the
opportunity to do it, so I give it away,”
he said.

Matthew, Laura and Gracen
Lasconia, along with the couple’s
“other son” Makalani, who is
half Chihuahua, half long-haired
Dachshund

Successful treatment
results in son
After trying to conceive for several
years, Chandler residents Matthew and
Laura Lasconia consulted an infertility
specialist. But a few unsuccessful
treatments, followed by surgery,
prompted Laura, 42, to think a different
approach was in order. In January of
2011, she and Matthew, 41, met with
Dr. Jay Nemiro, medical director of the
Arizona Center for Fertility Studies, and
underwent two cycles of IVF as well as
chromosome testing.
During the first round of IVF,
testing determined the embryos
had abnormalities, so they were not
implanted. The second IVF cycle,
however, was successful. Their son,
Gracen Kamahiwaokalamaku — his first
name celebrates his arrival occurring “by
the grace of God,” and his middle name
celebrates Matthew’s Hawaiian heritage
and is translated as “the child that is
cherished by the sacred light of God” —
recently turned one year old.
—GREMLYN BRADLEY-WADDELL

EXPERTS
GENERAL SURGERY
Christopher Salvino, MD, FACS
Dr. Salvino is a graduate of Loyola University Chicago Stritch School
of Medicine. He completed both his general surgical residency
and his trauma fellowship at the Loyola University Medical Center.
Board certified in general surgery, Dr. Salvino specializes in trauma,
acute care and abdominal wall reconstruction.

A graduate of University of Virginia School of Medicine in
Charlottesville, Virginia, Dr. Johnson completed his residency and
internship at University of Rochester Surgical Residency Program in
Rochester, New York. Board certified in Surgery and Surgical Critical
Care, Dr. Johnson specializes in the treatment of critically ill surgical
patients, severe acute pancreatitis, abdominal sepsis, trauma, and
general surgical conditions. As program director for the Surgical
Residency Program, he is also committed to training the highest
quality surgeons for the state of Arizona.

When you’re looking for a doctor who’s going to take
care of you and your family for years to come – you need
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GYNECOLOGY/ OBSTETRICS
Paul Mikel, MD
Dr. Mikel cares for women at every stage of life and has a special
interest in preventive medicine, hormonal balancing and optimizing
nutrition. Dr. Mikel is board-certified and graduated from the School
of Medicine at the University of California at Irvine before completing
both his internship and residency at the Phoenix Integrated Residency
in Obstetrics and Gynecology in Arizona.

Participants sought
for ASU School
of Nutrition and
Health Promotion
exercise study

BY MEGHANN FINN SEPULVEDA

I

n 2011, the Centers for Disease Control
and Prevention reported 22,791 children
in the United States were treated at an
emergency room for choking injuries. That
same year, six children died in Arizona
from choking incidents.

A

Hot dogs, grapes and more

“A latex balloon acts like
plastic wrap when a
toddler or child aspirates
a piece while choking.
It tightly and completely
covers the airway.”
— David Curran, M.D., pediatrician
at East Valley Children’s Center
and chairman of the department
of pediatric medicine at Cardon
Children’s Medical Center

Balloons, balls and buttons

Small round objects like coins, marbles
and balls, along with household items
such as pen caps, paper clips, balloons and
buttons, also pose a serious choking risk.
According to the Consumer Product
Safety Commission, latex balloons are
considered among the most dangerous of
these types of hazards and are responsible
for half of all choking fatalities in children
under age 14. Suffocation can occur when
a child tries to blow up a balloon and

THINKSTOCK

“The top food-related choking hazard in
young children is hot dogs,” said David
Curran, M.D., chairman of the department
of pediatric medicine at Cardon Children’s
Medical Center in Mesa. “The shape of a
hot dog mirrors the size of a young child’s
airway and the spongy texture causes it to
lock into place so no air can pass through
during a choking episode.”
Other common foods that can cause
choking include nuts, cheese sticks,
grapes, popcorn, peanut butter and
raw vegetables.

then deeply inhales. The entire balloon or
pieces of it can conform to a child’s airway
which then becomes obstructed.

Risk of aspiration

When a child suffers from choking, there
is an increased risk of aspiration involving
food particles or foreign objects that get
trapped in the lungs. This can ultimately
lead to respiratory problems such as
irritation, infection, or in more severe
cases, erosion of the esophagus. Children
who experience aspiration typically
require surgery, spend time recovering in
the intensive care unit and need follow-up
therapy.
“We can’t stress enough how important
it is to be knowledgeable and aware of
choking hazards in your home,” said Sally

Moffat, director of injury prevention at
Phoenix Children’s Hospital. “Think of your
child’s airway as the size of a paper-towel
roll. If an item can fit through that 1.5-inch
opening, then it is a choking hazard.”

SU’s School of Nutrition and Health
Promotion (SNHP) is recruiting
women between the ages of 45 and
60 for an exercise study using the Wii
Fit. To participate, women must not be
taking hormone replacement therapy
or osteoporotic drugs and should
be sedentary (no regular, purposeful
physical activity). In addition, participants
should have low bone mass; study
directors can screen for this if candidates
do not know their bone mass.
Study details: The 12-week study
includes three visits that last
approximately one hour each. The visits
involve a blood draw, muscular testing,
some balance testing and ultrasound
measures of the heel bone. The first and
last visits also include a DXA scan for
bone mass. Testing takes place in the
Arizona Biomedical Collaborative (ABC-1)
building on the corner of Fifth Street and
Van Buren in downtown Phoenix.
All exercises are done in-home;
participants will be asked to play directed
games three times a week for 30 minutes.
Owning a Wii is not necessary since
women randomized into the intervention
group will be lent all Wii equipment
during the study period. At the end
of the initial 12-week study, those in the
control group will have the opportunity
to borrow a Wii system for 12 weeks.
Participants who complete the study
will receive $25, have parking costs
reimbursed and be entered into a
drawing to win one of two Wii packages
consisting of a console, balance board,
controller and three games.

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6 | LIVING WELL A-Z | WEDNESDAY, October 2, 2013

October
Take advantage of more than 100 opportunities for
you to meet others with similar issues and learn more
about various aspects of your health – from A to Z.
All groups and events are believed,
but not guaranteed, to be free unless
otherwise stated. Every effort has been
made to verify accuracy, but please call
before attending to confirm details.

stem cell or bone marrow transplant
is standard treatment for patients
with life-threatening blood, immune
system or genetic disorders, replacing
unhealthy blood-forming cells with
healthy ones.
Be The Match Foundation, which is
operated by the National Marrow Donor
Program and has a regional center in
Phoenix, provides a link for patients
and donors.

How to donate

Be The Match donor drives, where
potential donors can register and provide
cell samples through cheek-swabs, are
listed on the Be The Match website
(BeTheMatch.org), or can be found by
calling the Phoenix office of Be The Match
at 602-277-1390.
In addition, those interested in being
a potential donor can sign up on the Be
The Match website and a swab kit will be
mailed out with instructions. Please note
that the Phoenix office is not set up to
register potential donors on a walk-in basis.

Who can donate

Be The Match recruits for donors ages
18-44; there is no cost to these potential
donors to register. Potential donors ages
45-60 must pay for their own testing,
which costs $100. (For the Be The Match
system, 60 is the upper age limit.)

State Sen. Anna Tovar
(D-Tolleson)

A second chance
Patients get a second chance at life
and donors can be heroes, said State
Sen. Anna Tovar (D-Tolleson). “To
know that one person can make that
difference, it’s such a great act of
kindness,” she said.
When Tovar was diagnosed with a
severe and rare form of leukemia in 2001,
her brother donated bone marrow for a
transplant.
“If I didn’t have my transplant, I would
have died,” Tovar said. Tovar needed
a second transplant in 2002, and her
brother was able to donate stem cells.
Since then, she’s been cancer-free.

What you need to know
Open Enrollment dates are
Oct. 15 through Dec. 7 BY DEBRA GELBART

If you are Medicare-eligible, you need to sign up for
Medicare coverage during the Medicare Enrollment
Period which is completely separate from the Affordable
Care Act’s Health Insurance Marketplace and its
coverage for those under age 65.

Considering changing plans?

How do you decide whether you should
change plans or options? Here’s advice
from Robert Matura, vice president of
Cigna Medicare of Arizona, and Jaime
Perikly, chief operating officer for Health
Choice Arizona, which operates Health
Choice Generations, HMO SNP, a health
plan for dual-eligible enrollees who qualify
for both Medicaid and Medicare.
• Medicare Advantage plans are offered by
private health insurance companies that
contract with Medicare. If you’re thinking
of changing to a Medicare Advantage plan
(or keeping your current Advantage plan),
make sure your favorite doctors are part of
the plan’s network. “If you’re attached

If you have questions about coverage
options, free assistance is available by
calling the senior helpline that’s part of
the State Health Insurance Assistance
Program (a nationwide program operated
in Arizona by the Area Agency on Aging
Region One) at 602-264-2255. In addition,
you can call Medicare at 1-800-MEDICARE.

Medicare definitions
• Medicare Part A: Hospital insurance
(according to medicare.gov, most
people get this premium-free)
• Medicare Part B: Traditional
Medicare
• Medicare Part C: Also known as
Medicare Advantage, these plans
are offered by private health
insurance companies that contract
with Medicare

Resources

• Medicare Part D: Drug coverage
to a particular doctor, it’s important to
determine if he or she will be contracted
with the Medicare Advantage plan
you’re going to select in 2014,” Matura
said. Provider contracts can change from
year to year, even with the same plan,
Perikly said. “With traditional Medicare
(Part B), you can see any provider you
wish,” she said. “But provider networks
within a Medicare Advantage Plan
are limited.”
• If you want to select or keep Medicare
Part B (traditional Medicare), make sure
your doctors will continue to accept
Medicare-enrolled patients. A reduction
in reimbursement rates from the
government in 2014 may prompt some
doctors to change their policy and
no longer accept Medicare patients,
Matura said.

Using veterans to help reduce
Medicare readmission rates
Program is a national winner of the 2012
White House Healthcare Policy Challenge

A

Area Agency on Aging Region
One: aaaphx.org; 602-264-2255
Medicare.gov (the official
U.S. website for Medicare):
medicare.gov; 800-633-4227

Senior Medicare
Patrol: Fighting
Medicare fraud
Composed of volunteers who
are retired seniors, members
of the Senior Medicare
Patrol (SMP) give community
presentations to teach
Medicare beneficiaries how
to do their part to prevent
fraudulent Medicare claims.
The program is operated by
the Administration on Aging,
part of the U.S. Department
of Health and Human Services.
In Arizona, the program is
overseen by the Division of
Aging and Adult Services
within the Department of
Economic Security.
To arrange a presentation
about preventing Medicare
fraud for your church group,
community group or senior
center, call the Area Agency
on Aging Region One at
602-264-2255. To find out
more about becoming a SMP
volunteer, call 602-542-6439 or
visit www.azdes.gov/daas/ship/
ferretoutfraud. Currently,
176 SMP volunteers conduct
outreach in Arizona; more
volunteers, both English- and
Spanish-speaking, are needed
statewide.

EXPERTS
CATARACT & REFRACTIVE SURGERY
Scott A. Perkins, MD

As a nationally recognized ophthalmologist with Barnet Dulaney
Perkins Eye Center, Dr. Perkins has performed more than 50,000
cataract surgeries and more than 10,000 vision correction procedures
such as LASIK and Implantable Contact Lenses (ICLs). As an innovator
in the ﬁeld of ophthalmology, he has participated in over 25 clinical trials
for both pharmaceutical and ophthalmic devices.
In addition, Dr. Perkins serves on the Board of Directors for Arizona
Visionaries, a donor driven non-proﬁt organization providing cataract
surgery and eyeglass ﬁttings in third world countries. He is not only
trusted for his surgical talents and modest nature, but is also well known
for his compassion and ability to connect with and comfort patients.
Board Certiﬁed by the American Board of Ophthalmology
Member of the American Society of Cataract and Refractive Surgery
Fellow of the American Academy of Ophthalmology

penalties for readmission rate increases
were built into the CMS campaign.
John C. Lincoln’s program hires veterans
as transition coaches who provide
designated Medicare patients with support
and guidance related to follow-up medical
instructions, doctor appointments,
nutrition and costs of care.
In the long run, reduced readmissions
generated by the transition coaches produce
significant savings for John C. Lincoln
that far exceed program costs. But initial
assistance to maximize the program’s
effectiveness was needed. To help, the Del E.
Webb Foundation awarded a $500,000 grant
to support and expand the transition coach
service. The funds will allow the program to
expand to 14 transition coaches by 2014.

PHOTO USED WITH PERMISSION OF JOHN C. LINCOLN

program that hires military combat
medics and corpsmen to care for
discharged elderly patients has reduced
the John C. Lincoln Hospitals’ Medicare
patient readmission rates to 6 percent.
Before the program started last year, the
rates were approximately 18 percent
(the national average is 20 percent).
The Centers for Medicare and Medicaid
Services (CMS) launched a campaign
to encourage hospitals to do whatever
necessary to maintain the health of
discharged Medicare patients with
congestive heart failure, heart attacks or
pneumonia, so fewer of them would be
readmitted within the first 30 days after
leaving the hospital. Financial incentives
for readmission rate reduction and

“Most Medicare Advantage plans will
cover urgent and emergency care only
while you’re away from home, not routine
care,” Matura said. “So if you see your
doctor every few months because you
have a chronic medical condition, you
would have to pay for a routine visit outof-pocket while you’re somewhere else.”
Traditional Medicare (Medicare Part B) and
a Medicare supplement plan (also called
“Medigap”) might be more appropriate
if this scenario applies to you, he said.

Questions?

Medicare Open Enrollment

If you are a current Medicare enrollee and
want to change your current Medicare
plan or options for 2014 (adding/deleting
drug coverage, or Part D, for example),
you can do so during the Medicare Open
Enrollment Period which begins Oct. 15,
2013 and runs through Dec. 7, 2013.
Even if you’re satisfied with your current
Medicare plan and options, experts say
that it’s still a good idea to review your
plan and find out during Open Enrollment
if anything has changed, which often
happens. If you want to keep the plan and
options you currently have, you don’t have
to do anything — you will be automatically
re-enrolled for 2014 with the same plans
and options that you have now.

• Check to see if the benefits important to you
are part of the Medicare Advantage plan
you’re considering. Prescription drugs are
typically part of a Medicare Advantage
plan, but are separate when traditional
Medicare is selected. You must enroll
in Parts B and D if you want traditional
Medicare with a prescription drug
benefit. Medicare Advantage plans
typically offer lower limits for out-ofpocket spending and co-pay amounts,
Matura said.
• Consider whether your health has changed
in the past year. If you think you may
need surgery in the next 12 months, for
example, you’ll want to find out if there
are restrictions related to surgery in a
Medicare Advantage plan, Perikly said.
• Are you a part-time resident? If you spend
part of the year outside Maricopa
County, Matura said, and you want to
select a Medicare Advantage plan, you’ll
need to arrange to receive your routine
medical care in Maricopa County.

Former U.S. Navy corpsman and John C. Lincoln transition coach Kathy Orona, right,
checks the blood pressure of Medicare patient Kathleen Reed, Glendale, during a wellness
visit. Reed’s health-check results are entered into her electronic medical record by
John C. Lincoln transition coach Letty Fred, also a former U.S. Navy corpsman.

Locations throughout Arizona
(800) 966-7000 / www.GoodEyes.com

PAIN RELIEF
Dr. Theodore Manos
Dr. Manos is a Board Certified Specialist in Anesthesiology and
Pain Management. He specializes in procedures such as epidural
steroid treatments and facet joint block procedures that
can relieve lower back pain and help improve patient’s daily
comfort level. Whether it’s arthritis, a herniated disc, sciatica
or spinal stenosis of the lower back, his treatments can help
patients regain mobility and functionality. These treatments can
help eliminate or reduce the use of oral pain medications that
patients may be taking on a regular basis. Anyone experiencing
chronic lower back pain may be a candidate. In most cases,
pain therapy can last for long periods of time. During the first
appointment Dr. Manos will evaluate the patients’ unique
condition and develop a treatment plan specific to their needs.
Cigna Medical Group | Outpatient Surgery Center
3003 N. 3rd Street, 2nd Floor
Phoenix, AZ 85012
602.282.9600

GENERAL SURGERY
G. Paul Dabrowski, MD, FACS
Dr. Dabrowski joined the full-time faculty and staff of Banner Good Samaritan
Medical Center in 2008. He is currently the medical director of Banner Good
Samaritan’s Level I Trauma Center. He received his medical degree from the St.
Louis University School of Medicine in St. Louis, Mo. in 1990 and completed his
general surgery training and two additional years of fellowship in Surgical Critical
Care and Trauma Surgery at Tulane University School of Medicine in New
Orleans, La. He is board certified in both General Surgery and Surgical Critical
Care. Dr. Dabrowski has many years of experience in trauma leadership. He
is a member of many state and national and is State Faculty for the Advanced
Trauma Life Support program. He is a captain (select) in the Medical Corps
of the U.S. Navy, He is presently the chief of Professional Services for the 4th
Medical Battalion, 4th Marine Logistics Group, U.S. Marine Corps.
Banner Good Samaritan Medical Center
Specializing in General Surgery
1111 E. McDowell Road, Phoenix
(602) 839-2000 www.BannerHealth.com/GoodSam
AR-0008084428-01

WEDNESDAY, October 2, 2013 | LIVING WELL A-Z | 9

Continued from cover HEALTHY AGING

6

9

RICK D’ELIA

Address
symptoms
of depression.

5
frail.

Avoid
becoming

“Frailty is the most
under-diagnosed condition in older
people,” said Nikolich-Zugich of
the Arizona Center on Aging at
the UA College of Medicine. Frailty,
he explained, is not dependent
on body type. “Frailty is partly
defined by loss of grip strength and
loss of muscle mass that results in
an inability to walk well,” he said,
adding that muscle strengthening
exercises throughout life can
combat this.
Frailty can also be characterized
by depression and diminished
mental capacity, Nikolich-Zugich
said, emphasizing that both of
those conditions can be kept at bay
with regular exercise. “Once you
become frail, your health can get
onto a downward slope,” he said.
“But we know that you can prevent
frailty with the right steps, including
exercise and good nutrition.”

“The World Health Organization
conducted a survey and found that
depression is the leading cause of
quality life years lost,” said Aaron
Boor, D.O., a family medicine
physician with John C. Lincoln’s
Del Lago Family Medicine in
Peoria. “If people talk with their
doctor about their symptoms and
either start talk therapy or take
appropriate medication, the vast
majority will get better with time.”

Mitigate
unnecessary

risk. “Make sure you wear a

helmet when you ride a bike and
make sure if you’re going to climb a
ladder that it’s situated safely,” Boor
said. “Accidents and injuries are the
most common cause of death for
people up to age 45.”

“Activity is critically
important. ‘Use it or
lose it’ is really true.”

7

Choose
supplements
carefully.

10

Stay
on-guard
against health
threats. “Research has

demonstrated,” Nieri said, “that if by
age 70, you don’t smoke, don’t have
diabetes, don’t have high blood
pressure (or it’s under control),
you’re not obese and you are
physically active, you have greater
than a 50 percent chance to live
to 90.”

More is not better when it comes
to supplements, said NikolichZugich, whose research focuses on
how the immune system declines
with aging. “The supplement
industry is poorly regulated,” he
said, “and there are no national
guidelines.” He suggests Vitamin D
supplementation and encourages
people to consume adequate
amounts of Omega-3 fatty acids,
which can be found in foods like
salmon. He also advises talking with
your physician about nutritional
supplements.

8

Maintain
social
connections.

“Socialization is extremely
important,” Nieri said. “Social
support can help you have
a successful recovery from
a heart attack.”

ABOVE: Walter Nieri, M.D., a geriatrician and internal medicine physician and
director of Banner Sun Health Research Institute’s Center for Healthy Aging, works
with Barb Feyereisen, 73, of Sun City, tracking various indicators of her health.
RIGHT: Feyereisen turns the tables on Dr. Nieri by asking him to try the grip
strength test. Nieri has been conducting a longevity study for six years. He says
that as you age, it is important to incorporate exercise that promotes endurance,
muscle strength, flexibility and balance.

SPECIAL ADVERTISING FEATURE

Dr. Kevin Ellis
Chief Medical Officer,
Cigna Medical Group

Coordinated Care: The Team
Approach to Better Health

W

hat is Coordinated Care?

Coordinated care is a way to deliver
health care through teamwork among primary
care doctors, specialists and other health care
professionals, with a special focus on prevention
and the management of chronic disease. Many
studies show that more efficient primary care also
helps lower costs in the long term by emphasizing
prevention and reducing unnecessary procedures.
By linking specialists, hospitals and other
caregivers, patients can count on a single point
of contact – a “medical home” – for clear
answers, personal help and peace of mind. This
is especially important for seniors, who often live
with many chronic conditions.
Studies show roughly half of patients do not
follow their doctor’s orders. Coordinated
care provides more patient education and
encouragement to comply with the doctor’s orders
so they stay healthy. As a result, coordinated care
has been proven to reduce emergency room visits,
hospitalizations, nursing home stays and other
expensive interventions by increasing control of
the chronic diseases of age.

A Focus on Quality
The traditional healthcare system treats patients
after they are already sick or experiencing
complications, forcing doctors to practice reactive
rather than preventive medicine. Under this system,
doctors get incentives to bill early and often.
Coordinated care takes a different approach. Rather
than pushing doctors to see high numbers of patients
and spend a short amount of time with each one,
coordinated care brings the focus back to the allimportant doctor-patient relationship. Doctors receive
assistance with patient tracking, communication and
paperwork, so they have more time for face-to-face

AR-0008082949-01

AR-0008086588-01

interaction. They can also provide more preventive
services and screenings, which lead to earlier
diagnosis and better health outcomes.
At Cigna Medical Group, for example, we’ve
had great success with the coordinated care
concept. We see the primary care doctor as the
“quarterback” working with specialists to manage
each patient’s health. In fact, Cigna Medical
Group has been certified by the National
Committee for Quality Assurance (NCQA) as a
level three Patient-Centered Medical Home. This
means that all 22 locations have received the
highest level of recognition for meeting national
quality standards in coordinated care.
This doctor-led, patient-centered team approach
enables open communication among all
health care professionals and specialists. The
coordinated care method helps doctors practice
medicine the way it was intended, with the
patient’s good health as the top priority.
The result is better care, healthier patients and
reduced healthcare costs.

Coordinated Care in Action
People over age 65 are especially vulnerable to
medication mishaps. It’s vital that you communicate
with your doctors, and crucial that your doctors
communicate with each other. In fact, it’s not
exaggerating to say good communication can
mean the difference between life and death.

Now’s the Time
One of the most important aspects of
coordinated care is the emphasis on preventive
healthcare. Talk with your primary care doctor
today about annual exams, tests and other
preventive steps you can take now to stay healthy.

Go from a life
of back pain

to a lifetime of living.

Not an actual patient of Laser Spine Institute

FINALLY, AN ALTERNATIVE TO TRADITIONAL OPEN BACK SURGERY. It’s time for you or a loved one to stop
suffering. Do what more than 35,000 people have done and get your life back. If you’ve been putting off neck or back
surgery, come learn about a proven technique that’s minimally invasive. BRING YOUR MRI OR CT SCANS and meet
one-on-one with our physicians who will review them and discuss treatment for your speciﬁc condition.

Learn more by attending our

FREE MEDICAL SEMINAR
on neck and back surgery options.
Saturday, October 5 at 10 a.m.